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January 5, 2015March 11, 2015

A Touchy Subject: Abortion in the United Kingdom and the Republic of Ireland

Robbie Travers – Executive Director

Abortion has been one of the most controversial social issues of the last half of the past century and remains unceasingly so even in this century. It would be, however, incorrect to conclude abortion is a modern concept as it was mentioned in Ancient Egyptian literature and by philosophers from the Ancient Greek World, such as Aristotle. This essay will evaluate religious and secular responses in the United Kingdom and the Republic of Ireland. It shall firstly discuss legal aspects of abortion, and how the differing legal positions in the United Kingdom, Northern Ireland and the Republic of Ireland create varying ethical challenges. Furthermore, this essay will also examine various philosophical views and stances on the issue of abortion. This essay will then evaluate aspects of Christian religious communities’ stances on abortion. Finally, this essay shall consider the problems surrounding medical ethics regarding abortion.

Just over forty percent of women have the right to seek induced legal abortions

The legality of abortion is something that varies globally. Just over forty percent of women have the right to seek induced legal abortions (CULWELL, KR et al. (July 2010). “Critical gaps in universal access to reproductive health: Contraception and prevention of unsafe abortion”. International Journal of Gynecology & Obstetrics). In the United Kingdom, the Abortion Act of 1967 set out clear guidelines, criteria and conditions a case must satisfy in order to be allowed to proceed with the “termination of pregnancy”. Another one of these conditions is that “abortions must be carried out in a hospital or a specially licensed clinic.(NHS. Introduction. http://www.nhs.uk/conditions/Abortion/Pages/Introduction.aspx) ” This aspect of the law is clearly designed to stop unsafe abortions, and statistics from “Why Mothers Die 2000-2002″(SAUNDERS, P J. “How many women really died from Abortions prior to the abortion act?” Christian Medical Comment.) published on behalf of the General Registrars Office demonstrate this aspect of the law has helped to dramatically limit the number of deaths of women due to abortion from eighty per million maternities in 1960 to the current figure of 3 per million maternities in 2002(SAUNDERS, P J. “How many women really died from Abortions prior to the abortion act?” Christian Medical Comment.). This aspect of the law is designed to reduce the number of maternal deaths in the procedure, however some, for example, P. J. Saunders, an ex-abortion specialist would argue “[In] each of these abortions a human death occurs, that is a baby dies.(SAUNDERS, P J. “How many women really died from Abortions prior to the abortion act?” Christian Medical Comment.)“ Saunders has also stated that abortion could be considered “legitimised murder”. Yet, this argument is not in any way compelling, as not only does it rely on strongly evocative and emotive language by referring to the foetus as a “baby”, despite there being a categorical difference both in legal and philosophical thinking, but it seems to neglect that by almost completely removing the possibility of unsafe backstreet abortions, many women’s lives are now being saved.

The second criterion of the 1967 Abortion Act any procedure must fulfill is that “two doctors must agree an abortion would cause less damage to a woman’s physical or mental health than continuing with the pregnancy.(NHS. Introduction. http://www.nhs.uk/conditions/Abortion/Pages/Introduction.aspx).” This element of the law is designed to stop clinical malpractice and to ensure the abortion system cannot be abused. The Royal College of Obstetricians and Gynecologists have stated it was also put in place so women and medical professionals considered the procedure “seriously”. However, there are moves by RCOG to remove the dual signatory aspect. They argued “widespread closure of family planning clinics in the UK have restricted women’s access to abortion procedures. (RCOG. Brieifing on Human Fertilisation and Embroyology. http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/human-fertilisation-and-embryology-bill/brie-1)“

“Widespread closure of family planning clinics in the UK have restricted women’s access to abortion procedures.”

This bureaucracy has been seen as causing unnecessary delays, but as the college itself has admitted, there are many instances in which “the opinion of a second doctor is highly desirable,” such as “late diagnosis of severe fetal abnormalities or if the woman has very challenging personal circumstances. (RCOG. Brieifing on Human Fertilisation and Embroyology. http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/briefings-and-qas-/human-fertilisation-and-embryology-bill/brie-1)” Some, however, feel the two signatory laws is necessary. When YouGov polled the public on the matter, many objected to the removal of dual signatory aspect as a legal requirement. Some of those polled suggested it was harder to be coerced into an abortion or make a rash decision if two doctors were considering the case (YouGOV. Poll – Are two doctors better than one. http://yougov.co.uk/news/2012/05/24/abortion-are-two-doctors-better-one/). Others felt it safeguarded the patient and doctors, as “the position of the mother (needs safeguarding as), she is in an intensely vulnerable position personally (YouGOV. Poll – Are two doctors better than one. http://yougov.co.uk/news/2012/05/24/abortion-are-two-doctors-better-one/)”. Many pointed out the scrutiny of two doctors is also beneficial and that two doctors can give “valid second opinions regarding health risks” and that it can prevent “any illegal foul-play or allowance of abortion on over sympathetic grounds (YouGOV. Poll – Are two doctors better than one. http://yougov.co.uk/news/2012/05/24/abortion-are-two-doctors-better-one/)”. In contrast, however, many feel that mothers who seek abortion should not need to obtain a second opinion. There is “no UK legal precedent to have a second opinion made compulsory in any other procedure9 YouGOV. Poll – Are two doctors better than one. http://yougov.co.uk/news/2012/05/24/abortion-are-two-doctors-better-one/)”. A strong argument exists to alter the law on doctors requiring the acquisition of two doctors’ signatures on abortion approval, as it simply seems over bureaucratic.

The above criteria allow women to undergo abortion procedures until 24 weeks of pregnancy (NHS. Introduction. http://www.nhs.uk/conditions/Abortion/Pages/Introduction.aspx). There are some exceptions to this rule. The first case is where it is deemed absolutely necessary to “save the woman’s life”. While there may be considered a problem concerning the abortion of a foetus, which may have some level of awareness, the death of the mother in most instances would not allow the foetus to survive. It could be argued that it is morally correct that the law decides to save the mother in this instance. The second exception to this criterion is “to prevent grave permanent injury to the physical or mental health of the pregnant woman(NHS. Introduction. http://www.nhs.uk/conditions/Abortion/Pages/Introduction.aspx),” and the third instance is “if there is substantial risk that if the child were born, s/he would have physical or mental abnormalities as to be seriously handicapped.(NHS. Introduction. http://www.nhs.uk/conditions/Abortion/Pages/Introduction.aspx)“ That said, some legal and ethical experts, such as Professor Sally Sheldon, have questioned whether the mental health component is being used only for mental health, and subsequently, if its misuse is a reprehensible thing:

Sheldon’s argument is perhaps weak, as her suggested tolerance of gender selective abortion under UK law could be seen to be slightly distasteful. Yet, there is a concern here about the wellbeing of the mother and the extent to which that “wellbeing” can be used to justify an abortion on medical grounds. It could be put to Sheldon that the problem that needs tackling there is cultural problem, and medical practitioners should not try to tackle cultural problems and speculate cultural impacts, but should make the decision to grant an abortion on a legitimate legal and medical grounding. Others, such as Emily Jackson, Professor of Law at the London School of Economics, have argued that these cases are few, and therefore pose an insignificant risk:

This argument against revision of current legislation seems flawed. It is worth considering that misuse of criterion of the Abortion Act may only represent an extreme of malpractice. Simply because one extreme of the problem of ambiguous definitions has arisen, this does not mean that these problems are altogether unimportant.

In considering secular response to Abortion in the UK and Ireland, it is pertinent to the situation in Northern Ireland, an area of the UK that, significantly, the 1967 Abortion Act does not apply to(Legislation.gov.uk, Abortion Act of 1967, http://www.legislation.gov.uk/ukpga/1967/87/introduction?view=extent. Currently, abortion is only allowed for pregnancies where “the mothers life is directly endangered or her mental or physical well being would be damaged in the long term.(Legislation.gov.uk, Abortion Act of 1967, http://www.legislation.gov.uk/ukpga/1967/87/introduction?view=extent)” This restriction of abortion to only severe medical cases has arguably caused a phenomenon known as “abortion tourism”. It is estimated that every year since 2010, “1,400 to 2,000 women have traveled to the mainland of UK to have terminations”.

It is estimated that every year since 2010, “1,400 to 2,000 women have traveled to the mainland of UK to have terminations”

It has been argued that Northern Ireland’s conservative stance on abortion does not actually halt abortion, it results in young women spend excessive amounts of money to afford a termination. Audrey Simpson, Belfast Centre’s clinical director has even stated “women who cannot afford to travel to the UK for abortions are flying to cheaper alternatives, like the Netherlands, or purchasing abortion pills from the internet.(DOUGAN, Patrice. Abortion Law changes urged as conference defies protests. Belfast Telegraph. http://www.belfasttelegraph.co.uk/news/local-national/northern-ireland/abortion-law-changes-urged-as-conference-defies-protests-28564074.html )“ What is clear is that where there is a will there is a way, and that the prohibition of abortion, no matter what the objections of those on the pro-life side are, has seemingly caused more women to turn to dangerous and expensive alternatives. Simpson also argued that it has caused the transformation of abortion into a taboo subject, meaning that instead of “detailing responses to abortion and pregnancy as a transparent society,” women are left in the dark and make “ill-informed decisions”. Simpson, furthermore, argued the prohibition and taboo surrounding abortion “may actually be counter productive”. Many women who are educated on the matter and speak to medical experts receive balanced information on the procedure actually choose not to go ahead with the procedure. In contrast, many under the current system are currently uneducated on risks of abortion.

The political will to change this situation is non-existent in Northern Ireland. According to current voting records accurate as of 2012, 106 out of 108 politicians in Stormont back current laws on abortion. Abortion law is also the one area that almost all political parties and religious factions mainly agree on in Northern Ireland, meaning there is little potential for any legislative amendment. It is also worth noting that the aiding or abetting of abortion, and carrying out the procedure in Northern Ireland is seen as a very serious criminal offence, with many sentences in this area being life.

Turning to the Republic of Ireland, which has recently changed its laws regarding the status of abortion(BBC News. Irish abortion bill becomes law. 30 July 2013. http://www.bbc.co.uk/news/world-europe-23507923). Despite significant reform of these laws, however, the majority of its abortion law is still derived from early UK Abortion law, specifically the Offences Against the Person Act 1861. Irish law still has many contradictory articles. While the Offences against the Person Act 1861 decrees that:

“58. Every Woman, being with Child, who, with Intent to procure her own Miscarriage, shall be guilty of [an offence], and being convicted thereof shall be liable, …, to [imprisonment] for Life ….

This statute still in place is eventually going to be augmented or replaced by the Protection of Life During Pregnancy Act 2013, which despite gaining ascent as a law, remains unimplemented. This change to the law “makes legal provisions for women who require a termination of their pregnancy on terminal medical ground(BBC News. Irish abortion bill becomes law. 30 July 2013. http://www.bbc.co.uk/news/world-europe-23507923)“. This law, however, still contradicts Ireland’s Eighth Amendment to the 1932 Constitution of the Republic of Ireland, which designates that the “The State acknowledges the right to life of all unborn, and guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.” The Republic of Ireland’s government, despite wishing to bring more clarity to the issue, seem to have made the situation even more complex by passing yet another law on abortion that seems to not have validity when related to other articles of the Irish Constitution and law.

The Republic of Ireland’s government, despite wishing to bring more clarity to the issue, seem to have made the situation even more complex by passing yet another law on abortion that seems to not have validity when related to other articles of the Irish Constitution and law.

This contradiction has been raised by the Free Presbyterian Church, which argued that despite there being “no scripture in which [sic] directly denies abortion, there are still scriptures that teach us to respect women and the unborn child before and after birth.” Regardless of the responses to the churches views, it raises the valid point that: “The [Free] Presbyterian Church has told the Oireachtais Joint Committee on Health and Children that any legislation regarding abortion must honour the constitutional status of human life.(Presbyterian Ireland. Presbyterians call for Pro-Life Abortion Policy. http://www.presbyterianireland.org/News/Article/2013-%281%29/Presbyterians-Call-for-Pro-Life-Abortion-Policy-wi?feed=cfd8e3f5-88c6-46c8-9f48-6f31a698b9b7)” There is a sound point to be considered in that Doctor’s can be even more confused by the fact that the Irish constitution restricts them from practicing abortion, yet the current legal framework being introduced seems to contradict this. It could be argued that this contradiction would allow Doctor’s to follow two different strategies, therefore creating a dichotomy of practice within the medical system, which could have devastating effects on the lives of women across Ireland due to the serious nature of the abortion procedure.

The Halappanavar report highlighted an ethical dilemma present in medical ethics, mainly surrounding four principles set out by Beauchamp and Childress in 2001, which are considered as the “standard moral framework of biomedical ethics(Bedford EL. Abortion: at the still point of the turning conscientious objection debate. HEC Forum. 2012 Jun;24(2):63-82. doi: 10.1007/s10730-011-9156-7. http://www.ncbi.nlm.nih.gov/pubmed/21769599 )“. Abortion seems to create many problems within this framework, with the principle of non-maleficence seemingly condemning abortion, but the principle of autonomy seemingly providing strong support for a women to choose what happens in regards to her own body. E.L. Bedford has argued that it is a woman’s “fundamental right” to self autonomy to choose what happens to her own body, therefore Bedford also argues that ethically, it must be a woman’s choice. Judith Jarvis Thomson made the pertinent violinist analogy to support the principle of autonomy. Thomson has written that:

“You wake up in the morning and find yourself… in bed with an unconscious violinist… He has been found to have a fatal kidney ailment… you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist’s circulatory system was plugged into yours… …To unplug you would be to kill him.”” (THOMSON, Judith Jarvis. The use of analogies in moral argument. BMJ http://jme.bmj.com/content/26/6/466.full)

Thomson makes the point that while it would not necessarily be morally altruistic to save the violinist by keeping him plugged in, it would certainly be a commendable, moral thing to do. But what Thomson argues is that just because it is a morally commendable thing to do, that does not mean that someone who “unplugs the violinist”, so to speak, would be morally reprehensible. This is a strong argument, as Thomson identifies technically the other person is dead as without the essential support of the other person, they would perish. Thomson has another strong point; there is a difference between murder with intent, and the cessation of support that leads to death. Thomson also makes the point that abortion is also permissible because the foetus has no self-awareness, and therefore it would not be killing an “individual”. Thomson has also made a strong case about disregarding non-maleficence in selective cases, saying, “chemotherapy kills cells to save the whole, yet abortion in some instances kills cells with potential to improve the whole.”

However, the debate around personhood is controversial. Thomson described personhood as having “no definitive start and end point”. She also argues that things do not instantaneously become human after a defined, universalised moment. This objection to the definition of personhood is strong, and reinforces the fact that development of the foetus will “vary in every individual case”, therefore creating a guideline is not only problematic but also almost impossible. Eminent American theologian and ethicist, Joseph Fletcher defined personhood through his own set of criteria. Abortion theorists often utilise his criteria, however, much of this criteria causes significant problems.

Thomson described personhood as having “no definitive start and end point”. She also argues that things do not instantaneously become human after a defined, universalised moment.

Fletcher’s first criterion is problematic: “1. Minimum intelligence: Below IQ 40 individuals might not be persons; below IQ 20 they are definitely not persons.” Not only is there no accurate way of testing the IQ of an embryo, but it depends as to whether you believe those with “mental retardation” are indeed a person (CLSF. Mental Retardation. http://clsf.info/Articles/mental_retardation_definition.htm). While Fletcher argues that “[I] cannot disagree they are human by genetics, they are not human in functional intelligence.” But does this not legitimise the killing of those who are mentally retarded, Fletcher’s second criteria, which is also strongly advocated by Baroness Mary Warnock, is equally problematic, “2. Self-awareness: We note the emergence of self-awareness in babies; and we note when it is gone, for instance, due to brain damage.” This argument is strong in the fact that it differentiates between organisms that have a concept of their own existence, but it seemingly falls apart on examination of the subjective term of self-awareness.

Where is the categorical boundary of self-awareness? Arguably, some of those who suffer from the more extreme forms of dementia show less awareness of themselves than young toddlers do, so therefore it is reasonable to assume that this criterion could be used to legitimise infanticide. Furthermore, on close examination, Fletcher’s third criteria could also be seen to be weak, “3. Self-control: Because a person understands cause and effect, he or she can effectively work toward fulfilling freely-selected goals.” What level of understanding of cause and effect does someone need to be a person, since it can be argued effectively there are fully developed humans that lack understandings of their actions consequences. Does this mean that those who lack this awareness, perhaps those with severe learning difficulties, are not a person? This criterion, while effective in separating a foetus from a human individual, seems significantly flawed(FLETCHER, Joseph. Personhood criteria. (24/03/14) http://www.tc.umn.edu/~parkx032/B- PERSON.html).

Religious responses to abortion not only polarise Irish politics, but they also hold significant sway amongst the people of Ireland.

Religious responses to abortion not only polarise Irish politics, but they also hold significant sway amongst the people of Ireland. The Roman Catholic Church is the Republic of Ireland’s dominant religion and Christian denomination. It maintains a vehement opposition to abortion, with Pope Francis declaring that abortion was part of a “throwaway culture(BBC news, Pope Francis condemns abortion http://www.bbc.co.uk/news/world-europe-25723422)“, and that it was “horrific” that “adults could somehow fail to ensure a proud leafy for themselves”. The Vatican and Roman Catholic Church have always had a strong stance that abortion is murder, but there stance on personhood, that “life begins at conception” is an evolution of thought and contrasts from the position of much earlier Popes, who backed the view of Aristotle, that life began at “40 days for boys and subsequently later for girl.” It is perhaps an offensive view that abortion is a “throwaway” act, when it is one of the hardest and most emotionally charged decisions that any women will make in her life. However, what is interesting is that the current leader of the church is trying to change the previously condemnatory attitude of it towards women who have had an abortion to that of a more forgiving institution. Pope Francis has said that the church “must do more to minister to women who have had abortions(ERTELT, Steven.Pope Francis has been an uncompromising yet compassionate pro-life leader during first year. Life News. http://www.lifenews.com/2014/03/13/pope-francis-has-been-an-uncompromising-yet-compassionate-pro-life-leader-during-first-year/)“ and to “show them the error of their ways in a gentle fashion and forgive them as our lord does.”

This change to a more forgiving church, which is more willing to discuss abortion and forgive about it, is a sign of modernisation. However, the Catholic Church supports abortions on two medical grounds – the first being an ectopic pregnancy and the second being cervical cancer and the removal of the womb entirely. However, there are several medical instances in which the Catholic Church does not support abortion, as it is tampering with the foetus that is forbidden, not the removal of the womb without tampering with the foetus. One of these instances is when the uterine wall ruptures and while the rupture is not fatal to the usually five-month-old foetus, it can kill the mother in hours. Another is when a woman suffers from cardiac disease and pregnancy puts severe stress upon her. In both cases, because uterine contents must be removed, the church opposes these abortions because they tamper with the foetus. This is arguably nonsensical, however, as in either situation, the foetus’ chances of survival are incredibly low outside the womb. Surely it would be best to save one life, rather than lose both (FAUNDES, Anibal. The Human Drama of Abortion. A global search for consensus. Barzeletto.).

Presbyterians share varying, yet similar stances to Catholics, which in Ireland, is unusual since these denominations are usually divided. While they accept there are exceptional cases in which abortion is acceptable. They argue:

Emotional language seems to have been deployed here, by the Presbyterian Church of Ireland labeling abortion as “wrong”. Surely, an action that saves the life of another human being is both desirable and morally commendable, rather than letting both die. While the termination may not be a pleasant thought, it is a life saving operation that will save one, rather than losing both lives.

The Free Presbyterian Church has been dealing with a theological dilemma with the issue of abortion since its foundation. The General Assembly of the Free Presbyterian Church concluded, “the artificial or induced termination of pregnancy is a matter of the careful ethical decision of the patient, . . . and therefore should not be restricted by law . . .” The Free Presbyterian Church equally oppose Abortion, but they show a moderate and reasoned understanding when they appreciate that some women will abort the foetus regardless of the stance of the government on the matter. Moreover, the Irish Council of Churches opposed anti-abortion laws, yet they oppose abortion on a case by case basis and oppose “cosmetic abortion” and “abortion on demand systems” (The Journal. The Irish Council of Churches opposed anti-abortion amendment. http://www.thejournal.ie/1982-irish-council-of-churches-opposed-anti-abortion-amendment-709821-Dec2012/).

Certainly, prohibition of abortion will not stop it, it simply makes abortion more unregulated, less safe and something of which people are less informed about.

Abortion is clearly a divisive issue, but what is clear is that all significant and sizeable majorities accept abortion is indeed necessary on some medical grounds. However, the points raised by Audrey Simpson are still relevant. Certainly, prohibition of abortion will not stop it, it simply makes abortion more unregulated, less safe and something of which people are less informed about. It can also be argued that “cosmetic abortion” and “abortion on demand” are terms that are demeaning to women who make critically important decisions about their future. Moreover, it could be also argued that women are having “abortion on demand” because they know little about abortion. Perhaps a less prohibitive stance would reduce the societal taboo abortion faces. Until people are informed about abortion, and until society has a greater knowledge of family planning – Ireland faces being left in the obscure realms of outdated law, while the UK continues to discuss approaches to abortion, and therefore, move forward as a collective.